Need for a nutrition-specific scientific paradigm for research quality improvement

Nutrition science has been criticised for its methodology, apparently contradictory findings and generating controversy rather than consensus. However, while certain critiques of the field are valid and informative for developing a more cogent science, there are also unique considerations for the study of diet and nutrition that are either overlooked or omitted in these discourses. The ongoing critical discourse on the utility of nutrition sciences occurs at a time when the burden of non-communicable cardiometabolic disease continues to rise in the population. Nutrition science, along with other disciplinary fields, is tasked with producing a translational evidence-base fit for the purpose of improving population and individual health and reducing disease risk. Thus, an exploration of the unique methodological and epistemic considerations for nutrition research is important for nutrition researchers, students and practitioners, to further develop an improved scientific discipline for nutrition. This paper will expand on some of the challenges facing nutrition research, discussing methodological facets of nutritional epidemiology, randomised controlled trials and meta-analysis, and how these considerations may be applied to improve research methodology. A pragmatic research paradigm for nutrition science is also proposed, which places methodology at its centre, allowing for questions over both how we obtain knowledge and research design as the method to produce that knowledge to be connected, providing the field of nutrition research with a framework within which to capture the full complexity of nutrition and diet

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group.

Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option

What Matters Most for Children: Influencing Inequality at the Start of Life

This paper provides an overview of the science of early childhood and summarizes the disparities and the opportunity gaps stemming from inequalities. It also describes categories of programs, services and policies for children birth to age 3 that might affect the extent of inequality and provide supportive early life experiences

Low-grade inflammation, diet composition and health: current research evidence and its translation

The importance of chronic low-grade inflammation in the pathology of numerous age-related chronic conditions is now clear. An unresolved inflammatory response is likely to be involved from the early stages of disease development. The present position paper is the most recent in a series produced by the International Life Sciences Institute's European Branch (ILSI Europe). It is co-authored by the speakers from a 2013 workshop led by the Obesity and Diabetes Task Force entitled ‘Low-grade inflammation, a high-grade challenge: biomarkers and modulation by dietary strategies’. The latest research in the areas of acute and chronic inflammation and cardiometabolic, gut and cognitive health is presented along with the cellular and molecular mechanisms underlying inflammation–health/disease associations. The evidence relating diet composition and early-life nutrition to inflammatory status is reviewed. Human epidemiological and intervention data are thus far heavily reliant on the measurement of inflammatory markers in the circulation, and in particular cytokines in the fasting state, which are recognised as an insensitive and highly variable index of tissue inflammation. Potential novel kinetic and integrated approaches to capture inflammatory status in humans are discussed. Such approaches are likely to provide a more discriminating means of quantifying inflammation–health/disease associations, and the ability of diet to positively modulate inflammation and provide the much needed evidence to develop research portfolios that will inform new product development and associated health claims

ESPEN Guideline on Clinical Nutrition and Hydration in Geriatrics

Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. Conclusion: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used

The epidemiology and prevention of childhood obesity in Tehran, Iran

Childhood obesity is a recognised increasing public health problem in Iran, but no evidence for effective prevention strategies is available. The aim was to inform the development of an obesity prevention intervention for Iranian school children. A quantitative analysis was used to examine the pattern and associated factors with obesity and a qualitative study explored the beliefs of parents and school staff about the causes of childhood obesity and potential interventions. Overall 28.2% of the children were overweight or obese and there was a non-significant tendency for increased energy intake with higher weight status. Measures of body fat were highly positively correlated with blood pressure. There was generally accurate body size perception among children and no relationship between weight status and quality of life scores. Focus group participants identified a range of perceived obesity risk factors related to diet and physical activity at the micro and macro levels. In terms of interventions, the importance of macro level activities was highlighted. The study confirms that childhood obesity is an important health problem in Tehran and highlighted socio-economic variations in prevalence, which will inform the targeting of prevention interventions. Important contextual information was obtained to inform the development of a prevention intervention

A Collaborative Approach to Designing an Online Nutrition Education Program for People with Multiple Sclerosis

This project has produced fundamental knowledge regarding the need and characteristics of a nutrition education program for people with multiple sclerosis (MS) and reinforces the importance of using co-design for end-user acceptability. The project has identified a theoretical framework and behaviour change techniques that support dietary behaviour change, as well as content, language, and design considerations for an online program that may improve the motivation of people with MS to make evidence-based, healthy dietary changes

Proceeding: 3rd Java International Nursing Conference 2015 “Harmony of Caring and Healing Inquiry for Holistic Nursing Practice; Enhancing Quality of Care”, Semarang, 20-21 August 2015

This is the proceeding of the 3rd Java International Nursing Conference 2015 organized by School of Nursing, Faculty of Medicine, Diponegoro University, in collaboration with STIKES Kendal. The conference was held on 20-21 August 2015 in Semarang, Indonesia. The conference aims to enable educators, students, practitioners and researchers from nursing, medicine, midwifery and other health sciences to disseminate and discuss evidence of nursing education, research, and practices to improve the quality of care. This conference also provides participants opportunities to develop their professional networks, learn from other colleagues and meet leading personalities in nursing and health sciences. The 3rd JINC 2015 was comprised of keynote lectures and concurrent submitted oral presentations and poster sessions. The following themes have been chosen to be the focus of the conference: (a) Multicenter Science: Physiology, Biology, Chemistry, etc. in Holistic Nursing Practice, (b) Complementary Therapy in Nursing and Complementary, Alternative Medicine: Alternative Medicine (Herbal Medicine), Complementary Therapy (Cupping, Acupuncture, Yoga, Aromatherapy, Music Therapy, etc.), (c) Application of Inter-professional Collaboration and Education: Education Development in Holistic Nursing, Competencies of Holistic Nursing, Learning Methods and Assessments, and (d) Application of Holistic Nursing: Leadership & Management, Entrepreneurship in Holistic Nursing, Application of Holistic Nursing in Clinical and Community Settings